Pediatric Surgery International

, Volume 34, Issue 7, pp 769–774 | Cite as

Effectiveness of gabapentin as a postoperative analgesic in children undergoing appendectomy

  • Katherine J. Baxter
  • Jennifer Hafling
  • Jennifer Sterner
  • Adarsh U. Patel
  • Helen Giannopoulos
  • Kurt F. Heiss
  • Mehul V. Raval
Original Article



Though gabapentin is increasingly used as a perioperative analgesic, data regarding effectiveness in children are limited. The purpose of this study was to evaluate gabapentin as a postoperative analgesic in children undergoing appendectomy.


A 12-month retrospective review of children undergoing appendectomy was performed at a two-hospital children’s institution. Patients receiving gabapentin (GP) were matched (1:2) with patients who did not receive gabapentin (NG) based on age, sex and appendicitis severity. Outcome measures included postoperative opioid use, pain scores, and revisits/readmissions.


We matched 29 (33.3%) GP patients with 58 (66.6%) NG patients (n = 87). The GP group required significantly less postoperative opioids than the NG group (0.034 mg morphine equivalents/kg (ME/kg) vs. 0.106 ME/kg, p < 0.01). Groups had similar lengths of time from operation to pain scores ≤ 3 (GP 12.21 vs. NG 17.01 h, p = 0.23). GP and NG had similar rates of revisit to the emergency department (13.8 vs. 10.3%, p = 0.73), readmission (6.9 vs. 1.7%, p = 0.26), and revisits secondary to surgical pain (3.4 vs. 3.4%, p = 1.00).


In this single-center, retrospective cohort study, gabapentin is associated with a reduction in total postoperative opioid use in children with appendicitis. While promising, further prospective validation of clinical effectiveness is needed.


Gabapentin Appendectomy Abdominal surgery Opioid epidemic Analgesic 



Enhanced recovery protocol


Visual analog scale


Length of stay


Morphine equivalents in mg



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare. Institutional Review Board approval was obtained prior to chart review and all protected health information was kept strictly confidential. Informed consent was waived given the retrospective nature of the study.


  1. 1.
    Manchikanti L, Helm S, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV (2012) Opioid epidemic in the United States. Pain Physician 15(3 Suppl):ES9–ES38PubMedGoogle Scholar
  2. 2.
    Rudd RA, Aleshire N, Zibbell JE, Gladden RM (2016) Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly Rep 64(50–51):1378–1382. CrossRefPubMedGoogle Scholar
  3. 3.
    Edlund MJ, Forman-Hoffman VL, Winder CR, Heller DC, Kroutil LA, Lipari RN, Colpe LJ (2015) Opioid abuse and depression in adolescents: results from the national survey on drug use and health. Drug Alcohol Depend 152:131–138. CrossRefPubMedGoogle Scholar
  4. 4.
    Galinkin J, Koh JL, Committee on D, Section On A, Pain M, American Academy of P (2014) Recognition and management of iatrogenically induced opioid dependence and withdrawal in children. Pediatrics 133(1):152–155. CrossRefPubMedGoogle Scholar
  5. 5.
    Hill MV, McMahon ML, Stucke RS, Barth RJ Jr (2017) Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg 265(4):709–714. CrossRefPubMedGoogle Scholar
  6. 6.
    Yan PZ, Butler PM, Kurowski D, Perloff MD (2014) Beyond neuropathic pain: gabapentin use in cancer pain and perioperative pain. Clin J Pain 30(7):613–629. PubMedCrossRefGoogle Scholar
  7. 7.
    Larson DW, Lovely JK, Cima RR, Dozois EJ, Chua H, Wolff BG, Pemberton JH, Devine RR, Huebner M (2014) Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery. Br J Surg 101(8):1023–1030. CrossRefPubMedGoogle Scholar
  8. 8.
    Short HL, Taylor N, Thakore M, Piper K, Baxter K, Heiss KF, Raval MV (2017) A survey of pediatric surgeons’ practices with enhanced recovery after children’s surgery. J Pediatr Surg. CrossRefPubMedGoogle Scholar
  9. 9.
    Mayell A, Srinivasan I, Campbell F, Peliowski A (2014) Analgesic effects of gabapentin after scoliosis surgery in children: a randomized controlled trial. Paediatr Anaesth 24(12):1239–1244. CrossRefPubMedGoogle Scholar
  10. 10.
    Rusy LM, Hainsworth KR, Nelson TJ, Czarnecki ML, Tassone JC, Thometz JG, Lyon RM, Berens RJ, Weisman SJ (2010) Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial. Anesth Analg 110(5):1393–1398. CrossRefPubMedGoogle Scholar
  11. 11.
    Peng C, Li C, Qu J, Wu D (2017) Gabapentin can decrease acute pain and morphine consumption in spinal surgery patients: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 96(15):e6463. CrossRefGoogle Scholar
  12. 12.
    Parikh HG, Dash SK, Upasani CB (2010) Study of the effect of oral gabapentin used as preemptive analgesia to attenuate post-operative pain in patients undergoing abdominal surgery under general anesthesia. Saudi J Anaesth 4(3):137–141. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Sen H, Sizlan A, Yanarates O, Senol MG, Inangil G, Sucullu I, Ozkan S, Dagli G (2009) The effects of gabapentin on acute and chronic pain after inguinal herniorrhaphy. Eur J Anaesthesiol 26(9):772–776. CrossRefPubMedGoogle Scholar
  14. 14.
    Siddiqui NT, Fischer H, Guerina L, Friedman Z (2014) Effect of a preoperative gabapentin on postoperative analgesia in patients with inflammatory bowel disease following major bowel surgery: a randomized, placebo-controlled trial. Pain Pract 14(2):132–139. CrossRefPubMedGoogle Scholar
  15. 15.
    Feng C, Anandalwar S, Sidhwa F, Glass C, Karki M, Zurakowski D, Rangel SJ (2016) Beyond perforation: Influence of peritoneal contamination on clinical severity and resource utilization in children with perforated appendicitis. J Pediatr Surg 51(11):1896–1899. CrossRefPubMedGoogle Scholar
  16. 16.
    Kishner S (2018) Opioid equivalents and conversions. MedscapeGoogle Scholar
  17. 17.
    Helander EM, Webb MP, Bias M, Whang EE, Kaye AD, Urman RD (2017) A comparison of multimodal analgesic approaches in institutional enhanced recovery after surgery protocols for colorectal surgery: pharmacological agents. J Laparoendosc Adv Surg Tech A 27(9):903–908. CrossRefPubMedGoogle Scholar
  18. 18.
    Poylin V, Quinn J, Messer K, Nagle D (2014) Gabapentin significantly decreases posthemorrhoidectomy pain: a prospective study. Int J Colorectal Dis 29(12):1565–1569. CrossRefPubMedGoogle Scholar
  19. 19.
    Paul JE, Nantha-Aree M, Buckley N, Shahzad U, Cheng J, Thabane L, Tidy A, DeBeer J, Winemaker M, Wismer D, Punthakee D, Avram V (2015) Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients. Can J Anaesth 62(5):476–484. CrossRefPubMedGoogle Scholar
  20. 20.
    Clarke HA, Katz J, McCartney CJ, Stratford P, Kennedy D, Page MG, Awad IT, Gollish J, Kay J (2014) Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block. Br J Anaesth 113(5):855–864. CrossRefPubMedGoogle Scholar
  21. 21.
    Doleman B, Heinink TP, Read DJ, Faleiro RJ, Lund JN, Williams JP (2015) A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia 70(10):1186–1204. CrossRefPubMedGoogle Scholar
  22. 22.
    Fletcher ND, Andras LM, Lazarus DE, Owen RJ, Geddes BJ, Cao J, Skaggs DL, Oswald TS, Bruce RW Jr (2017) Use of a novel pathway for early discharge was associated with a 48% shorter length of stay after posterior spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 37(2):92–97. CrossRefPubMedGoogle Scholar
  23. 23.
    Choudhry DK, Brenn BR, Sacks K, Shah S (2017) Evaluation of gabapentin and clonidine use in children following spinal fusion surgery for idiopathic scoliosis: a retrospective review. J Pediatr Orthop. PubMedCrossRefGoogle Scholar
  24. 24.
    Short HL, Heiss KF, Burch K, Travers C, Edney J, Venable C, Raval MV (2017) Implementation of an enhanced recovery protocol in pediatric colorectal surgery. J Pediatr Surg. CrossRefPubMedGoogle Scholar
  25. 25.
    Haig GM, Bockbrader HN, Wesche DL, Boellner SW, Ouellet D, Brown RR, Randinitis EJ, Posvar EL (2001) Single-dose gabapentin pharmacokinetics and safety in healthy infants and children. J Clin Pharmacol 41(5):507–514CrossRefPubMedGoogle Scholar
  26. 26.
    Srivastava U, Kumar A, Saxena S, Mishra AR, Saraswat N, Mishra S (2010) Effect of preoperative gabapentin on postoperative pain and tramadol consumption after minilap open cholecystectomy: a randomized double-blind, placebo-controlled trial. Eur J Anaesthesiol 27(4):331–335. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Katherine J. Baxter
    • 1
  • Jennifer Hafling
    • 2
  • Jennifer Sterner
    • 2
  • Adarsh U. Patel
    • 1
  • Helen Giannopoulos
    • 2
  • Kurt F. Heiss
    • 1
  • Mehul V. Raval
    • 1
  1. 1.Division of Pediatric Surgery, Department of SurgeryEmory University School of Medicine, Children’s Healthcare of AtlantaAtlantaUSA
  2. 2.Department of PharmacyChildren’s Healthcare of AtlantaAtlantaUSA

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